HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE a.aiivIPLETED FOR APPLICATION TO BE ACCEPT rt, I
Date: /0-3'I' Permit Number:
SCANNED
BY
Building Permit Application St. Lucie County
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 5561 0I-A-A166 FWE 1:&4-T- ;V1's2cC- 1=C
Legal Description:
Property Tax ID #:
Site Plan Name: _
Project Name: _
Setbacks Front Back:
?-3a1- U001-6004
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: III
�L OC�cf 7X1.SnW6 77-'AicE2 W,,_7H- n/ccu OFr=i'cc STtRAc� *�i%�
j'?O v
CONSTRUCTION INFORMATION: III
Haamonai worxio ue errormea unaer uus Perrnn.—a
IIHVA( 11 Gas Tank Gas Piping
Electric 0 Plumbing OSprinl
Total Sq. Ft of Construction: % 960 f/
Cost of Construction: $ X/l000 , e
LJ Shutters ❑ Windows/Doors
ElGenerator E]Roof = Roof pitch
S Ft. of First Floor: _
Utilities:ll Sewer 0 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name. - JCW 1Lti//er- - i
Name: • .%D h J9244S
Address:.,5- 66. oCa:%%,' 4ve .,, ,,Company:
-John J''a 4ls consf/Lehbil, Snc_
=City:State: ' L--
Zip Code: ,1g147 Fax: -7'72 YG(--6r/91
Phone No. ?72
Address: *90/ Aleancfor AJe
City: Fr, f i�el_ State:
Zip Code: Wf-e2 Fax: 79.2-1/&(--4k%/
Phone No. 7;�2 A?2433V
E-Mail:)rm je-cobs ty JAW"l•Com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License: C /S C- 41G0 562/
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
'SUPPLEMENTAL CONSTRUCTRYN LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signatur f Owner/ ssee/Contractor as Agent for Owner
Signatur f Contract r/License Holder
STATE OF FLORIDA
COUNTY OF tmxk
STATE F FLORIDA
Sj CdAc%g,
COUNTY OF �
The forgoing instrument was acknowledged before me
The Toying instrument was acknowledged before me
thisJPj dayof Sepirmhar 201'7by
this�dayof 5e.4 fcw,{jef- 201by
-To A n Ticco b i
�3-04, J "0 1.1-r
Name of person making statement
Name of person making statement
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
ture of Notary Public- State of Florida
(Signature of Notary Public- Stat 0,
PATRICIA
;p.• STE
Commission No. in 62517 y f9tp COMMISSION # G
ENS D %' ., P-AprrTCRF IA STEVENS
0¢ fission No. G� +' -
EXPIRES September 7
MY08�1NTSION # GG02371
, 2020 f EXPIRES September 19, 2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
O
RECEIVED
DATE
COMPLETED
f/
Rev.8/2/17